6.1  Assess and classify fever

Malaria and measles are the two major illnesses where fever is likely to be a symptom (although you should not rule out either illness even if fever is not present).

Measles and malaria are both described in Communicable Diseases, Part 1; see Study Sessions 4 and 8 respectively.

Box 6.1 outlines the key symptoms and signs of malaria and the complications that can arise in an infant or child who has malaria.

Box 6.1  Malaria symptoms and possible complications

Fever is the main symptom of malaria. It can be present all the time or recur at regular intervals during the illness. Other signs of malaria are shivering, sweating and vomiting. A child with malaria may have chronic anaemia (with no fever) as the only sign of illness.

In areas with very high malaria transmission, malaria is a major cause of death in children. A case of uncomplicated malaria can develop into severe malaria within 24 hours of onset of the illness. The child can die if urgent treatment is not given.

Measles is another cause of fever. It is a highly infectious disease with most cases occurring in children aged between six months and two years. Box 6.2 below outlines the main symptoms and possible related infections that you need to be aware of if you are treating a child with measles.

Box 6.2  Measles: symptoms and complications

Fever and a generalised rash are the main signs of measles. Most cases occur in children between six months and two years of age. Measles is highly infectious. Overcrowding and poor housing increases the risk of measles occurring early in a child’s life.

Measles affects the skin and the layer of cells that line the lung, gut, eye, mouth and throat. The measles virus damages the immune system for many weeks after the onset of measles. This leaves the child at risk of other infections.

Complications of measles occur in many cases. The most important are: diarrhoea (including dysentery and persistent diarrhoea), pneumonia, stridor, mouth ulcers, ear infection and severe eye infection and blindness.

Measles also contributes to malnutrition because it causes diarrhoea, high fever and mouth ulcers, all of which can interfere with feeding. Malnourished children are more likely to have severe complications due to measles. This is especially true for children who are deficient in vitamin A. One in ten severely malnourished children with measles may die. For this reason, it is very important to help the mother to continue to feed her child during measles.

Learning Outcomes for Study Session 6

6.2  Assess fever